Type 1 diabetes requires lifelong insulin therapy because insulin-secretion capability is diminished. Glycemic control and glucose monitoring are important to prevent type 1 diabetes complications. Diabetes technologies have developed rapidly; continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII) are now common and greatly aid glycemic control, especially in children and adolescents. The National Health Insurance Service has provided partial reimbursements for both CGM and CSII devices since 2019 and 2020, respectively; the devices are thus expected to become more popular. CGM reduces the frequency of hypoglycemia and the level of glycated hemoglobin. CSII affords more precise glycemic control than multi-dose insulin therapy. CSII showed reduced frequency of hypoglycemia and improved metabolic outcome without an increase in the body mass index z-score. Technological advancement of combined CGM and CSII will eventually serve as an artificial pancreas. The National Health Insurance Service should fund not only the devices but also education of patients and caregivers. In addition, healthcare providers must be continuously updated on new diabetes technologies.
Citations
, Jun Hyeok Song Moyamoya disease is a cerebrovascular disease that features stenosis or occlusion at the distal internal carotid artery and proximal portion of the anterior and middle cerebal arteries. Before reversible changes occur to the brain revascularization surgery for patients of moyamoya disease is believed to prevent cerebral ischemic attacks by increasing and improving cerebral blood flow. The authors present the experiences of surgery for patents with ischemic or hemorrhage.
Revascularization surgeries were performed in 10 patents with episode of ischemic, seizure and hemorrhage between 1994 and 1999. There were 3 male and 7 female, aged 5 to 54(mean32.4 years) and 6 patients with ischemic, 3 patients with hemorrhage and 1 patient with seizure. Procedure of EDAS was performed in 4 patients with ischemic and 1 patient with hemorrhage. EMS was performed in 3 patients with hemorrhage and 1 patient with seizure. Combined EDAS and EMS was performed in 1 patients with ischemic. One superior cerebellar artery aneurysm was demonstrated and clipped and pseudoaneurysms was obseved in one patient. The authors studies the relationship between efficasy and outcome of surgical treatments.
All patients except one patient who died were followed up >3 years, from onset untill 1999. Improved and no recurred of symptoms and signs were observed in all patients who underwent EDAS procedure. Rebleeding was observed in 1 among 4 patients who underwent EMS procedure and the patient died of rebleeding 1 patient who underwent combined procedures EDAS and EMS resulted in improved and no recurrence of ischemic symptom. 1 superior cerebellar aneurysmal clipping was performed successfully. The pseudaneurysms arising dilating perforating moyamoya vessels in patient with hemorrhage were source of the hemorrhage and rebleeding.
The surgically treated patient seems to have good results, but long term study of large numbers of patient needs further investigation. Although the procedure of EDAS and EMS were successful in producing effective indirect arterial anastomoses and improvement in symptoms, superficial temporal artery middle cerebral artery(STA-MCA) anastomosis combined with indirect arterial anastomotic procedures were recommended as the appropriate surgical treatment for refracting cases of moyamoya disease.
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